Adaptive Text Messaging Intervention for Risky Drinking in Postpartum Women

摘要 拟议的R34将开发一个理论驱动的，自适应短信干预（TMI）的风险饮酒， 产后妇女危险饮酒在育龄妇女中很普遍，超过一半的妇女 怀孕期间减少饮酒的女性在三个月后恢复到怀孕前的水平 产后产后危险饮酒会损害母亲照顾婴儿的能力， 虐待和忽视儿童的风险增加，儿童福利系统的参与，以及长期贫穷， 孩子的结局。大多数从事危险饮酒的成年人不寻求治疗，产后妇女 由于耻辱和对儿童保护服务的恐惧， 参与。短信是一种很有前途的策略，可以接触到不寻求治疗的危险饮酒者， 可能特别适合产后妇女，因为它方便和匿名。这种方法还 具有广泛的可扩展性潜力，因为它能够以相对较低的成本覆盖大量人群。的 拟议的研究将采用多阶段优化战略（MOST）框架，一个工程启发 开发高效和可扩展的移动的卫生干预措施的方法，以开发第一个适应性TMI 专为产后妇女危险饮酒而设计。这项研究将完善一个理论 模型，以通知基于复发预防模型的TMI，并指定以下各项的时间关系： 压力，消极情绪，母亲自我效能感与饮酒意图和日常饮酒行为 产后妇女，以及她们对产后时期特有的触发因素的日常波动 （睡眠质量和婴儿烦躁）。拟议的TMI将包括行为改变干预措施， 动机访谈和认知行为疗法，目标是应对技能和动机，以避免 饮酒，并适应性地适应压力，消极情绪和自我效能的波动。具体 目的是（1）通过生态瞬时评估测试和改进所提出的理论模型， 妇女14天，以确定每天的压力波动，消极情绪，和自我效能， 触发因素及其对饮酒意图的影响;（2）通过以下方式制定TMI的内容和决策规则： 通过30名产后妇女的焦点小组收集的用户反馈的迭代周期;（3）进行试点 一项有50名妇女参加的微型随机试验（MRT），以评估设计和方法的可行性， 初步的概念验证数据，为未来的全面优化试验做好准备。研究产品将 一套初步的TMI成分产后危险饮酒，准备优化和评估， 未来更大规模的R 01，和一套试点EMA和MRT方法的人口产后风险 酒鬼

Abstract The proposed R34 will develop a theory-driven, adaptive text messaging intervention (TMI) for risky drinking in postpartum women. Risky drinking is prevalent among women of reproductive age, and more than half of women who reduce their alcohol use during pregnancy return to pre-pregnancy levels by three months postpartum. Postpartum risky drinking can impair a mother’s ability to care for her baby, and is associated with increased risk for child abuse and neglect and involvement with the child welfare system, as well as poor long- term child outcomes. Most adults who engage in risky drinking do not seek treatment, and postpartum women may be especially unlikely to seek formal treatment due to stigma and fears of child protective services involvement. Text messaging is a promising strategy for reaching non-treatment-seeking risky drinkers that may be particularly suitable for postpartum women, as it is convenient and anonymous. This approach also has wide scalability potential, as it is capable of reaching large numbers of people at relatively low cost. The proposed study will apply the Multiphase Optimization Strategy (MOST) framework, an engineering-inspired approach for developing efficient and scalable mobile health interventions, to develop the first adaptive TMI specifically designed for risky drinking in postpartum women. The proposed study will refine a theoretical model to inform the TMI that is based on the Relapse Prevention model and specifies the temporal relations of stress, negative mood, and maternal self-efficacy with intention to drink and daily drinking behavior in postpartum women, and their daily fluctuations in response to triggers that are unique to the postpartum period (sleep quality and baby irritability). The proposed TMI will include behavior change interventions based on motivational interviewing and cognitive behavioral therapy that target coping skills and motivation to avoid drinking, and that are adaptively tailored to fluctuations in stress, negative mood, and self-efficacy. Specific aims are to (1) test and refine the proposed theoretical model via Ecological Momentary Assessment with 30 women for 14 days to determine daily fluctuations in stress, negative mood, and self-efficacy in response to triggers and their impact on drinking intentions; (2) develop the content and decision rules for the TMI via iterative cycles of user feedback collected via focus groups with 30 postpartum women; and (3) conduct a pilot micro-randomized trial (MRT) with 50 women to assess feasibility of design and methods and obtain preliminary proof-of-concept data to prepare for a future fully-powered optimization trial. Study products will be a set of preliminary TMI components for postpartum risky drinking, ready for optimization and evaluation in a future larger scale R01, and a set of piloted EMA and MRT methods for the population of postpartum risky drinkers.